Figure 4

Different grades of CLNM on routine US, LCEUS and pathology. (a) Benign LNs and different grades of CLNM (thick arrows) on routine US. (b) Schematic of metastatic foci (black arrows)growing in parenchyma, marginal sinus (arrowheads), and lymphatic vessels (thin arrows) in different grades of LNs (thick arrows). (c) LCEUS shows perfusion defects (black arrows) developing within parenchyma, marginal sinus (arrowheads) and lymphatic vessels in different grades of LNs (thick arrows). The interruption was found in bright ring (arrowheads in Grade I to Grade IV) and lymphatic vessel (thin arrow in Grade IV). (d) Photomicrograph of surgically resected specimens shows tumor growing (black arrows) (H&E, × 10) (e) The dynamic process of tumor growth was showed on CK staining (CK, × 10). With the growth of tumor, the small foci (black arrows from Grade I to Grade IV) enlarged, fused with each other and occupied the entire LNs. (f) The growing of tumor (black arrows) leaded to progressive loss of lymphatic structure within LNs (thick arrows) (LCA, × 10). LN lymph node, CLNM cervical lymph node metastasis, US ultrasound, LCEUS lymphatic contrast enhanced ultrasound, CK cytokeratin, LCA leukocyte common antigen.